How are you feeling today . So often, the response to that question depends on a persons mood. People who have a positive mental attitude can deal with the challenges that come their way. They accept themselves, have an optimistic yet realistic outlook on life, and cope effectively with change. Deborah khoshaba a healthy person develops the kind of self care skills whether nutrition, exercise, self help and so forth develops the sort of skill sets where they are always developing their ability to engage in the world. The person whos in good health. Is able to do the things they want to do. There are not impediments to their being successful and productive at work, being engaged in their family, having social activities. They also are able to enjoy life. Yet, many people arent able to enjoy life. Their functioning impaired by some form of Mental Illness. James curran well, one of the largest problems in the world is Mental Illness. Its poorly understood, its stigmatized in virtually every society. The World Health Organization estimates that depression will be the most common cause of morbidity in the world, in the next several years. Its difficult to estimate problems such as anxiety, depression, other Mood Disorders affect our health. The causes of Mental Illnesses are often as varied as the people they affect. Paul mchugh some psychiatric disorders are due to a damage or an injury to the brain, and thus can be construed as diseases, and the problem that the patient faces in life is what they have. They have alzheimers disease, they have manic depressive disorder. They have schizophrenia. On the other hand, those arent the only ways that we can experience mental trouble in our life. Some of the things that give us trouble, is how were constituted. Not what we have, but who we are, will influence how we feel in certain situations, and sometimes how we feel in certain situations becomes so distressed, we need help with it. And then finally, everyone knows and appreciates that you can have difficulty in life because of whats happened to you, what youve encountered. Damage to the brain. The interplay of personality and environment. Difficult life situations. All can contribute to mental distress. So can family history. Andrew leuchter if an individual has a firstdegree relative, that is a father, mother, brother, sister, who suffers from bipolar disorder, manic depressive illness, or from depression, they are at significantly increased risk for having a Mood Disorder themselves. A Mood Disorder is an emotional state, that to some degree, interferes with social, familial, occupational functioning. The most common Mood Disorder throughout the world is depression. Andrew leuchter depression can strike anybody at any time. There is no way of predicting whos going to get depressed. Anybody from the highest functioning corporate executive, to somebody who is laboring daytoday, anybody can suffer from a depressive episode. I had a good life. I had good parents, i had a good upbringing, i had a good education. It was all good, pretty much. Andrew leuchter one way of thinking of depression is that we all have a normal mood regulating mechanism and we all go up and down, but its when you get stuck down, its not just that youve gone down, but you go down and you stay down for weeks. I was an adolescent, somewhere around 11 or 12, and i can remember sitting in our living room in the dark, and just not really wanting to communicate with anybody, not wanting to say anything, just and i would have these thoughts that said, they dont really love you. They dont like you. Youre not worth anything, and they were just over and over. And i just began to retreat and thought, well, ill just be quiet. Andrew leuchter if somebody comes in a stressful life situation, they have a depression, they say, doctor, this has never happened to me before. We treat them, they get well and they stay well. Unfortunately, many patients have had a previous episode and will go on to have huger episodes. Once one has had a single episode of depression, the lifetime risk of recurrence, the chances of having a second episode are about 50 , about a coin toss. Beverly when i got to be early 20s, and i worked at big General Hospital in the psych unit, no less, is when i began to really understand that there was something wrong, and that i needed some help. I ended up having a big episode of crying. I mean, i just cried. I cried for three days. I stayed home from work, and i you know, i had life problems but they werent huge. I had a job. It wasnt like i was going to be homeless or that kind of thing. I was just so down all the time. An obviously depressed mood is the most common manifestation of depression loss of energy, difficulty functioning on the job, feeling like you cant cope at home, feeling like you just want to withdraw and do nothing. I would go inside myself and feel inside myself, and not talk, not want to watch tv, not want to do anything, and then eventually, id go to a sleeping mode; id want to sleep a lot. You cant just say to yourself, snap out of it and get back on your feet. Some people with depression can force themselves to get out of bed, but they cant force themselves to enjoy life. They cant force themselves to concentrate. There are actual changes in neurochemistry in the brain, there are changes in hormones in the body. There are actual physical, biological factors that prevent the depressed patient from being themselves. That can be hard to convince people of. There is a tremendous stigma against Mental Illness in general, and depression in partular, in this society. And i kind of go into a shell when im having an episode, because i dont want to hear that its nothing, and that i can just, you know, pull up on my boot straps and move on, because sometimes you just cant. Andrew leuchter the key thing in terms of understanding depression is that this is an illness, not a weakness, and that we need to treat this illness in such a way that patients can get over it. Beverly i mean, if youre wheezing and you cant breathe, then people understand that theres something seriously wrong with you. But if in your mind youre not having okay thoughts, they cant see that, and they dont understand. And they dont have the compassion. The major struggle that we face in psychiatry, is, i suppose, overcoming the stigma associated with Mental Illness. Patients dont want to come in for treatment. They feel that theyre being labeled. The ability to get somebody into treatment, to provide adequate psychotherapy, is greatly hampered by the fact that there is commonly very, very little coverage for anything more than an initial consultation or maybe a medication visit or two. Ive had to look for clinics, free psych clinics, to get the support that ive needed. Ive been fairly fortunate in finding them, because i couldnt afford it. When i was going to virginia at the beginning of february to be with my daughter, it came up that i needed to get my medicine and it wasnt time yet with the insurance. So, i said, well, but im going to be out of town when time comes, and i need my prozac, you know. Gotta have it. And they said, well, they wont authorize it, so youll have to pay regular price, which was 400 for a one month supply. And at that point, i felt like, if i cant get my medicine, if i cant make enough money to buy it, i dont want to live. Andrew leuchter we have 20 different antidepressants on the market that differ in their particular chemical profile, and we want to choose which medication is most likely to help that individual as well. So, its a matter of getting the patient to stick with the treatment, encouraging them to work through any side effects they might have from medication, getting them to stick with treatment long enough for the antidepressant effects to kick in. Now have you noticed your mood change in the last couple of weeks . Yes. I tend to question my feelings, where as before, it was just how i felt. But now, is this me or is this the medication . You know, should i act on this, or should i ask somebody to look at me, or tell me if im okay . Andrew leuchter psychotherapy is vital in this. Number one, weve got to give the patient support they need, help them get over their life problems, but also offer some encouragement to stick with the course of treatment. Beverly it gives me a place where i can come and say anything about whatevers happening in my life, and not feel that im being judged for it. Because i depend on the philosophy that therapists are there to help and not to judge, and all of that. And i use that as my place to vent and talk about anything. If somebody has had a particularly severe depression i might tell them, i think you should stay on medication longterm, for many years, possibly for life. The medications we have now, the newer drugs, are pretty transparent to most patients. They cant tell theyre taking them, there are minimal side effects and no longterm risks to taking the medication. So there really is very little downside to staying on the medications. I told my girlfriend, i said, i feel like im on the edge of a cliff and i can fall off at any time, you know. And that i do kind of stumble and fall, but with the help of my medications, i dont fall so far and stay so long. Mood disorders are just one category of Mental Illness. Another is dementia when people experience impaired cognitive functioning, memory loss, delusions. Dementia can be caused by brain injuries and tumors, or it can be part of the aging process, as in alzheimers disease. One form of dementia is the thought disorder, schizophrenia. Andrew leuchter the most clear cut example of schizophrenia is where somebody has delusions or hallucinations. But the classic delusion would be. The belief that somebody is out to get you, that youre being followed, that youre being spied upon. Its frightening, at first. You cant distinguish reality from fantasy. There also are hallucinations, that one hears voices. It used to be kind of scary. Id just sit in my room and listen to the radio. I couldnt even watch tv for 4 or 5 years, because i just felt nervous. I dont know, the tv was sending out messages and stuff. In the last 30 years, as treatments for schizophrenia have become more sophisticated, victims have the hope of an most normal life. Andrew leuchter Antipsychotic Medication can help to dissolve hallucinations and delusions, but also can help to order thoughts can help to restore thought patterns to normal, and bring the patient out of a negative symptom state. Its pretty miserable without medication. I recommend a lot of people to be on medication if they need it. Some patients with schizophrenia will get back to normal function. Commonly patients with schizophrenia dont quite get back there, and we really need to work on rehabilitation and social skills training in addition to medication to maximize their function. Since ive started taking the medicine, and staying on it, i can distinguish reality from fantasy, and i say, hey, thats my illness, you know . There are patients who 20 years ago would have been locked up in an institution for life, who are now able to live in the community, commonly hold down some kind of job. The causes of schizophrenia are unknown, but the brains of people with this disorder tend to have biochemical or structural defects that may be inherited. Andrew leuchter when you look at the brain of a patient with schizophrenia what you commonly see is that first that there has been some shrinkage of the brain as compared with most adults of the same age group. The second difference that we can see is in the function of the brain. So using Something Like a pet scan or an eeg brain map, we would see that there was diminished function in certain brain areas particularly in the prefrontal regions of the brain, the very far forward areas. Its sort of like a crucial connecting point which in many ways, makes us what we are. The way we synthesize information, the way we make decisions, the way we reason. In recent years, the use of scanning techniques has changed the way we look at mental disorders. Now were doing research that ties together the elements of molecular biology that forms the brain, the image that we can now take of the brain with all these wonderful cat scans and mris, and functional mris and various kinds of things, and tie that with the clinical behaviors that we see. Many people, at some point in their lives, experience what is referred to as a panic or anxiety attack. Bulimia and anorexia nervosa are two such disorders that target teenage girls and young women. Michael strober in this case, the feared object, that which is phobically avoided is body shape, body fat. Its a morbid dread of body fat. Should i try it on . In anorexia nervosa, thats coupled with extreme weight loss, but in bulimia nervosa, one retains or maintains body weight within the normal range, and there is this pattern of overeating and vomiting. Anything that i was feeling that i didnt want to feel or that i didnt know what it was, i could just shove back every time i threw up, because it numbs you. And it may be a half an hour numb or a five hour numb, but, for a little temporary bit, everything disappears, until after when it hits you. And then it just starts over. Thats how the cycle begins. Adolescent girls who develop anorexia nervosa often share similar personality traits. Michael strober not that everyone with these traits will develop anorexia nervosa. In fact, its probably a very, very, very small minority of people who do. But they are traits such as extreme compliance, perfectionism, regimentation, the need for order and sameness and regularity of routines, a tendency towards apprehensiveness, self doubting, insecurity. Anorexics tend to be more introverted in the sense of more internally worried and also more stubborn in their thoughts about themselves and the world. Whereas the bulimics tend to be more extroverted, more outgoing, more creatures of the moment and then regretting their behaviors. High school is one of my favorite times. I did i ran cross country. I ran track. I did drama. I was always busy, no matter what. It was a great time. It was exciting, but it kind of lot of, i mean ups and downs in high school. So. Thats kind of where everything started. In many instances, there is no obvious triggering event, other than, i suppose, this stress associated with puberty and all that that entails, social changes, changes in the bodys shape and form, changes in family relationships which are just inherent to puberty. Its a time when you begin to seek out comforts outside the home. And for people with anorexia nervosa, and, to a certain extent, people with bulimia nervosa, that can be quite challenging. I was running and doing all that kind of stuff and really healthy and i had not eaten junk food for a year. And i had just said to myself, im not going to do it. And then it was christmas and i did just because it had been over a year and i can be like everyone else. And then i panicked. And i threw up for the first time that day and swore that would be the only time ever. That was four years ago. Its rare to develop anorexia nervosa after age 18 without having had a prior history of weight and shape preoccupation. Im not saying it doesnt happen but its uncommon. Bulimia nervosa tends to develop between the ages of 15 and 25. Erin chenoweth in the beginning, i cod care less what i looked like. s all about what i thought of myself and i was never happy enough with myself. I dont think that physically i ever based this on, oh, i have to weigh this much, or, this size clothes has to fit. That wasnt important. It was just how i felt and i thought that the more i removed myself from my state of mind that the better i would feel and that along with that came everything else. Eating disorders are complex illnesses. Successful treatment programs blend a combination of therapies, medical care and monitoring, psychotherapy, and nutritional counling. Erin chenoweth my friends used to tell me, well, why dont you just stop . Its not how it works. You get out of control, and your brain spins, and your body spins, and you have no way of putting your foot down. And the only way i wouldve been able to break the cycle is thats why i came here, because theres no way i couldve done it on my own. Well, the first thing that we try to do, and it can be quite difficult, is to have the individual settle in, and feel as comfortable as possible with this environment. Theyre frightened. Theyre actually petrified. They feel theyve entered a very dangerous place, not in terms of a threat to their physical safety but a threat to their psychological stability, their sense of integrity, because we are about to take something away that they hold very dear. They cherish, or at least they need it for their own sense of equanimity, self control, feeling of wholeness or accomplishment, whatever they attribute psychologically to this disorder. Erin chenoweth the physical part of the refeeding process is a nightmare. I mean, you go from not digesting food for six months because everything you eat is thrown up, and then youre being forced to eat three, four, five times a day, and have all this food sit in your stomach your body doesnt know what to do. It was terrifying to sit down and have my first meal be it was like, chicken and a tortilla, but never, in the past four years, have i been able to keep down either, you know, so it was terrifying for me to look and see all this food. Im, okay, you have to eat all this and sit with it, and be okay. And then the next morning, and then the next lunch, and dinner. It was just, for the first about five days, it was just sheer just terror for me to sit and eat the food, because it would just hurt. And it was so uncomfortable to eat that. The first change point is over the first couple of days where people recognize that their thinking is restored, their memory is improved, their concentration, and level of alertness is better. Their sleep is better, their general activity level is enhanced because of feeding. The brain has energy and it begins to work. And people thus recognize just how disabled they were by their starvation. When your brain gets fed and you can finally think for yourself, and start to be rational, Little Things remind you of what its like to be a normal human being. But then theres a second turning point that is much more is much less predictable as to when it occurs but very important, and that is the point at which people say, i think i need another life than the one ive been living. And thats a profound psychological transformation. And when you see it, you know that the person is moving towards health. The next step, believe it or not, is not to put them into individual psychotherapy, but to begin them in Group Psychotherapy with individuals who have suffered the condition or are further along in their recovery. Because its easy for a person with this way of life and these concerns to hold off an individual psychotherapist. But when theyre surrounded by young women who have been where they are, and know the kinds of rationalizations they use, this helps them to find their way further along into the treatment. The Group Therapy actually helps a lot because you walk into this place thinking youre the only one that thinks this way and youre the only one that has to go through all these things, but the more you talk to people, the more everyone has the same stories, and its kind of, oh, my gosh, youve done that, too. It made me feel so much better to hear other girls talking to me about the same things i was feeling because it made me feel like i wasnt crazy. Erin, youve been here two months now, and you have just resumed exercising, running, which i know, has been a passion of yours. Do you have faith in your ability to do it in moderation . I do. I mean, for two months here i didnt exercise, and i was okay with that. So im trying to just remember that at home, when i feel like i should be doing more, just remember that for two months i didnt, and i was okay. And in bulimia nervosa where theres often a feeling of loneliness and lack of close intimate relationships, the psychotherapy permits somebody to feel understood and respected and regarded and cared about. Thats very important to human beings. When you first came here, it was difficult, if not close to being impossible for you to have a sense of comfort with yourself, self acceptance. It was hard for you to be in your own skin. How do you feel about yourself now . I just try and look at everything that ive learned, and remember that in the back of my head, so that when i get discouraged, i can pull that back up. But it helps, im a lot more comfortable with myself. Paul mchugh finally, we look around with the patient to see whether there are particular things about her and her life which have fundamentally been triggers to this behavior. Im really trying to get away from the whole perfectionist its so i mean its difficult to try its setting yourself up for failure. One of the key challenges that we face in psychiatric treatment today is less the development of effective treatments and more our ability to utilize the treatments in the most effective way we can. Paul mchugh were going to understand how the brain and the body relate to the behaviors that ultimately are themselves shaped by life experience. Once we understand them at that kind of vital level, then i think that we can do what people want us to do, namely to free them from these particular burdens that deprive them of their humanity, that deprive them ultimately of that great thing that human that the Healthy Human being mentally has, namely his freedom, his freedom to choose, his capacity to develop a sense of responsibility for himself and his future, which are hindered with psychiatric disorders. I thought about a future and going to school again, and having a relationship with my parents and having my friends and having all these things that i want to in life, but having them completely, and being able to be a whole person as opposed to an eating disorder person, because it was so unpredictable and so up and down, and i know thats not who i am. I have learned that i need to cling to life. I want other people to know. That its worth trying. Its worth seeking help, that it can be better, that it really can be better. The human condition is a 26part series about health and wellness. For more information on this program and accompanying materials, call 18005762988 or vit us online at www. Intelecom. Org. Ox . Tnnogngngononaterials, call 18005762988 announcer the Bare Necessities of living healthy are easy. Just eat right, be active, and have fun. Yeah go to mypyramid. Gov to find out more. And then we have to come up with techniques to help individuals to learn to live with some of it because we cant do without it. A certain amount of conflict, its facilitating of growth, both on a personal as well as a social level. Stress, to me, before october 6, would have been a very busy day with a lot of activity. All that changed dramatically after october the 6th